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Skilled Nursing Facility Enrollment Screen Risk Category Updated January 1, 2023

Last updated on 5/12/2023

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

On November 18, 2022, the Centers for Medicare & Medicaid Services (CMS) published a final rule that revised the screen risk category for newly enrolling and reenrolling skilled nursing facility (SNF) providers from the lowest (limited risk) screen risk category to the highest (high risk) screen risk category. The screen risk category for revalidating SNFs was revised to the moderate screen risk category.

This revision is effective January 1, 2023, and the requirements are as follows:

  • Preenrollment and post-enrollment site visits
  • Fingerprint-based criminal background checks (FCBCs) for owners that have a 5% or more interest in newly enrolling and reenrolling SNFs

Providers may refer to the Affordable Care Act (ACA) Screening Requirements for additional information.

Preenrollment site visits will take place at the locations listed on the enrollment application, including business offices and any locations where clients receive SNF services.

A Texas Medicaid & Healthcare Partnership (TMHP) site visit coordinator will email or call providers to schedule a visit. If the TMHP site visit coordinator is unable to reach a provider, TMHP will conduct an unannounced site visit.

Reminder: The Texas Health and Human Services Commission (HHSC) encourages providers to confirm that their enrollment record with Medicare is up to date.

When a provider’s Medicare enrollment record is up to date and the Medicare enrollment information matches the information in the Medicaid enrollment application, then HHSC can rely on the site visit that Medicare conducted.

For more information, call the TMHP Contact Center at 800-925-9126.